Objectives: Food insecurity and diet-related chronic health conditions are interrelated problems in rural communities. The population facing such outcomes may rely on food pantries as a way to gain access to food. Many food pantries use a traditional distribution model that restricts choice. Yet, dietary recommendations and the need to economize food resources place many challenges on households. In this research, we sought to determine whether clients self-reporting chronic health conditions in their households have unique perceptions about food pantries and their ability to meet needs. Methods: We surveyed clients (N = 612) of limited or non-choice rural pantries, each representing a unique household. We classified clients into 3 groups: no chronic condition; one chronic condition or more, but no diabetes; one chronic condition or more including diabetes. We compared group perceptions of pantries. Results: All conditions desired more choice, and more preference for certain food groups such as produce and dairy. Clients with chronic conditions and diabetes in their household had a greater percentage of negative comments about the choices offered and were less comfortable talking to volunteers. Conclusions: Rural pantries may serve clients with chronic health conditions by offering client choice and by engaging with them regarding needs and preferences.